Provider Demographics
NPI:1891580254
Name:MITCHELL, BAILEY
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6823
Mailing Address - Country:US
Mailing Address - Phone:936-419-1300
Mailing Address - Fax:
Practice Address - Street 1:17844 MOUND RD # H
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4919
Practice Address - Country:US
Practice Address - Phone:346-545-4397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93663101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health